Delivering services in rural areas, views from the front line
Irregular buses, tight-knit communities and occasionally being stranded on an island — the challenges and rewards of providing recovery services in rural areas.
From the Scottish Highlands to the Wessex Downs, rural Britain has long been renowned for its beauty. But while these places draw visitors from all over the world, the people who live and work there face unique challenges.
Public sector cuts have left most local healthcare providers trying to do more with less across geographically large and diverse areas. But the power of community is also strong in these places, the specific history and heritage of an area creating a strong sense of shared identity.
Working in the drug and alcohol sector in this environment can be challenging but also rewarding. We asked three members of staff from some of Addaction’s most remote areas about what difficulties and possibilities they see in their communities.
Peter Ellerton — Project Worker, Argyll and Bute
Argyll and Bute, where I work, is a massive county. It’s also really far flung, stretching from Helensburgh in the East to Oban in the North West. My patch is the Kintyre peninsula, west of the Isle of Arran, including Campbeltown and the 50 miles up to Lochgilphead. So it’s a big geographical area, sparsely populated and it’s just me, 20 hours a week.
I’ve worked in Bristol, Bath, Glasgow and Paisley. It’s really different here. Drug supplies can be patchy and variable in quality. There’s fewer staff covering a larger area, meaning that lots of time is taken up with travel, so getting groups together and staffing them can be problematic. Lots of places you might refer clients on to, perhaps for specialist help, are not based here, so are only available via phone or a long journey.
While there are drugs here, the west coast of Scotland has a big history with alcohol. Campbeltown used to be a whiskey capital and there were 33 distilleries here at one time. It sustained a lot of people so is deeply embedded in the culture, but also I think that alcohol has become something people use to cope.
We don’t have an office in Campbeltown, the nearest is Oban 80 miles away. That means our presence here is very much relationship based, rather than being focused on a building, service or team. It’s just me and my phone.
We have to build relationships from the first moment. There are few drop in services so people have to make that leap to get in touch with us. The bulk of my work is one on one, creating, and helping people see through recovery plans. In the last six months we’ve started group work as well.
It also changes my work life balance quite significantly. One of the challenges is that I don’t have a team around me; so my support comes via telephone, or a team meeting once a month.
It’s hard to express, but there are fewer distractions here. Life is right here in all its beauty and harshness without the constant availability of distraction. This can make it easier to focus on recovery, but can also be hard on mental health. Communities are small and close-knit which, although making confidentiality a harder issue to get right, also means that I’m more likely to know, or know of my clients.
Steve Slade — Recovery Coordinator, Cornwall and Isles of Scilly
The Isles of Scilly are the most southerly point of the UK, with a population of about 2200 across five islands. I normally fly from Land’s End to St Mary’s, the largest and most populated island, which houses the health centre where most of my work is based. The other four islands can only be reached by a small boat.
One of the issues providing services to the Isles of Scilly is getting there. I rely on small planes which are frequently cancelled in bad weather, meaning service users continuity of treatment can be disrupted. Skype and telephone is offered but its not the same as face-face appointments. Sometimes, the reverse can happen, weather can come in quickly and I have been stranded on the Isles more than once.
The main substance I encounter on the Isles is drinking. For the size of the population there’s a large amount of licenced premises. They’re the focal points of the community. The pub is a place where the people of a tight community to go and socialise, especially during the winter months.
Addaction facilitated a lot of training over the last 2 years, including an alcohol detox facility at the local hospital. The challenge however is the aftercare, as the isolation of the Isles means that service users can’t access Addaction groups or twelve step fellowships as they would in Cornwall. In response to this there has been some good multi agency work so that other services can support in the absence of Addaction.
The Isles are heavily touristed in the summer months. This means that in the winter a lot of people don’t have work but over the summer they’ll be working long hours. It also means there’s a large influx of seasonal workers in summer, increasing the population by around 500 people. This tends to be a younger group, so we might see a higher rate of people using substances during those months. On these summer evenings there can be a lot of partying from this group mixed with locals. The dangers different to other areas, is the proximity to water in isolated areas. A message around keeping safe in this environment has been important in the keywork sessions.
Cornwall is a rural community anyway but in Scilly this is compounded. Due to the sensitivity of substance misuse work there can be a wariness of meeting with agencies in a tight knit community. However, my consistency and favourable word of mouth reports is helping with this. I’ve been working in this area for two years now, with the support of the health centre and other services we’re starting to see greater engagement and reduction in alcohol harms.
Jessica Snell — Recovery Coordinator, Cornwall
I cover the area of Bude, a seaside town in North Cornwall. The parish has just over 9000 people and the next town is a 30 minute drive. Our nearest hospital is Barnstaple, in the next county, an hour away. During the summer Bude thrives with visitors, but is very quiet the rest of the year. Like much of Cornwall, this means employment here is generally seasonal. There aren’t enough jobs locally but many of my clients are unable to drive to access work elsewhere.
Among my clients alcohol is widely used. However, I also often see cocaine used in young adults and more affluent groups, as well as those who work long shifts in the hospitality sector. There is a new Cocaine Anonymous group that has been opened in the area on a Saturday evening.
Being a rural area the community is very close, most people know most people. This can be a barrier as sometimes people don’t want to be seen coming to a drug and alcohol service. We counter this by hosting appointments in the community center, where many other services are housed. This helps reduce some of the anxiety around being seen to come to appointments.
On the other hand, having a close-knit community can help when someone is struggling with substances. Those who we have helped or know of our work are often at hand to offer contact details for our service.
Luckily for Bude, there are two clinic days per week to see clients as well as weekly support with a Mutual Aid Partnerships group, AA meetings and CA meetings. However with the case load being relatively high, there are barriers. With only two days per week to see up to ten clients per day, then taking into consideration no shows, training or annual leave, there can be long periods of time between appointments for many clients. As a result we sometimes have to offer telephone appointments instead, but these aren’t ideal.
Transport for clients can also be difficult in this area. Some buses only run every two hours, which means waiting in the town for long periods of time. This can be risky, as some clients might meet certain people, or go into the shops to buy alcohol. We try to offer appointments between the bus arrival and a group like AA, so people are able to fill their time in Bude with recovery focussed activities.
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If you or someone you love needs help or support, reach out. You can chat to a trained advisor at addaction.org.uk.
